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Monday, October 10, 2016

Vets Get Discouraged Too

Recently I had a very tough case.  A stray kitten about four months old ended up finding a family who took her in.  For the first few weeks she was fine, but then suddenly became sick and lethargic.  They were concerned that she had eaten a mouse that had died of poison.  One of my associate doctors saw her, ran typical tests (fecal, blood chemistries, blood cell count, etc.) and found her essentially healthy with no explanation for her symptoms.  She was sent home for observation.
Two days later she came back and I was working.  The kitten wouldn't stand up and though she was purring she was very weak.  We gave her some fluids and some food, which she ate readily.  The clients declined further diagnostics due to costs, so we observed her.  By the early afternoon she had improved and was standing up some.  But over the next few hours she worsened again.  The owners took her home and she died that night.
I talked to them the next day and because I was so puzzled I offered to do a necropsy (autopsy on animals) at no charge.  They brought her body in which had thankfully been placed in the fridge overnight.  I examined every organ and body system, including the brain, and could find no evidence of trauma, toxins, bleeding, organ abnormalities, or any abnormality whatsoever.  In essence this cat had normal internal structures and no explanation for her illness and death.  We could have sent tissue samples to a pathologist to try and find microscopic explanations, but the client couldn't afford that.
Three days, over $300 worth of testing, and a necropsy.  All without any answers.
I hate these cases.
Believe it or not, sometimes it's hard to figure out what is wrong with a patient.  My human colleagues have the same challenges.  We can run multiple tests and get normal results, yet still have a patient that's obviously not healthy.  Those tests aren't pointless because we can rule out certain possibilities and thus start to narrow down our list of disorders.  But in some cases I am more able to tell the client what their pet doesn't have than I can tell them what it does.
This can be very frustrating for the client, as it was in the case with this kitten.  I completely understand that!  They spend money and time doing what we recommend, and then we come back telling them that the tests were normal and we still don't know what's wrong.  It's not unusual for a client to wonder why we couldn't figure it out.  But that's the nature of medicine.  Sometimes we get an answer on the first set of tests.  Sometimes it takes multiple and increasingly specific diagnostics to get to a final answer, and that takes both time and money.
It's also frustrating for the vet!  I was nearly pulling my hair out the other day trying to figure out what was wrong with the kitten, especially when I didn't get any answers at all on the necropsy.  I went over multiple possibilities, all coming up empty or needing further testing.  Honestly, I was very discouraged by the case because I hate not being able to give an owner some kind of answer.  Even if it's bad news that may result in euthanasia, at least it's an answer and we're not left wondering.
Vets get into this field knowing that we won't make much money.  We do it because we care about animals and truly want to help people and their pets.  We can often take it personally when we lose a patient or can't make them better.  Depression is a big problem in my profession because we do get so emotionally involved yet we can't fix every animal.  We feel pressure from the clients we care about, but even more pressure from ourselves.  All of those years of training and experience, the latest diagnostic tools, but we still come up empty on answers.  "What am I missing?  How can I not figure this out?  How stupid must I be?"  Yes, these are real thoughts that I and many other doctors have had.
Losing a patient or not being able to diagnose an illness isn't something we take lightly.  We don't shrug it off and move on.  We linger over it as we keep running the case through our mind searching for that one clue that we missed.  Then we become incredibly discouraged that we didn't have a solution, sometimes second-guessing ourselves with future cases.
Being a vet isn't easy.  It's more mentally and emotionally draining than many people realize.